Pituitary abscess resulting in isolated abducens palsy.

Abstract

Primary pituitary abscess, excluding those secondary to previous trans-sphenoidal surgery, is a rare but lifethreatening sellar disease. We herein present the case of a male patient with an isolated abducens nerve palsy and anterior panhypopituitarism caused by pituitary abscess, which completely resolved after conservative antibiotic treatment. A 35-year-old man, with a history of allergic rhinitis, presented with malaise associated with progressive onset of frontal headache followed by diplopia for 3 days. On examination, his body temperature was 38 C with a complete paralysis due to right abducens nerve palsy; however, his visual acuity was intact (Figures 1Ae1D). Laboratory examination revealed the following measurements: white blood cell count 13,300/mL with 57% neutrophils and 32.4% lymphocytes; and C-reactive protein 42.9 mg/dL (0e8 mg/ dL). Endocrine evaluation demonstrated anterior panhypopituitarism with the following values: morning cortisol (cortisol AM) titer 0.282 mg/dL (5e25 mg/dL), thyroidstimulating hormone titer 0.185 mIU/mL (0.27e4.2 mIU/ mL), free thyroxine titer 0.595 ng/dL (0.93e1.7 ng/dL),